Archive for August, 2009

The American Journal of OB/GYN, July 2009 has a clinical opinion by Drs. Minkoff and Ecker entitled, “The California octuplets and the duties of reproductive endocrinologists,” in which they discuss the ethics and obligations of embryo transfer and those who do them.

They assert that reproductive endocrinologists need not consider the economic interests of society (patient on welfare), cannot refuse embryo transfer based on perceive parenting ability or lack thereof and can limit the number of embryos transferred both ethically and medically.

Leaving aside the moral issue of in-vitro fertilization and creating embryos for transfer, I noticed the logic used to justify limiting the number of embryos transferred parallels our arguments regarding rights of conscience.

They write, “Yet while respect for autonomy [patient autonomy–the ethic that trumps all in this day and age] is the central tenet of a principle-based approach to providing ethically appropriate medical care, there are important differences between “negative” and “positive” autonomy. Pregnant or not, a patient may decline any procedure or treatment offered her; she may not, however, demand and receive treatment that her provider feels is inappropriate or that is an undue risk to her health.”

Now why would such a statement apply to “any procedure or treatment”, as they state above, except abortion? The American College of OB/GYN in its ethics statement #385 contends any doctor refusing perform abortion or refer for abortion at the patient’s request is unethical. But here, Minkoff and Ecker make a blanket statement which would obviously contradict ACOG ethics.

Why should a pro-life OB/GYN doctor be obliged to perform a procedure (abortion) that her or she feels “is inappropriate or that is an undue risk to her health,” as our authors state above? According to the argument made by Drs. Minkoff and Ecker, such a pro-life doctor should not be obligated at all.

Now I don’t know Dr. Minkoff or Ecker, but I would guess they are not members of AAPLOG. Promotions into the higher reaches of academic medicine usually involve genuflection at the alter of “choice.” Maybe they should write a hasty addendum stating there argument does not apply to abortion lest someone use their names to argue for life in the halls of congress. How embarrassing would that be?

Once again, the lack of consistency in their arguments illustrates the true ethic ACOG uses against us pro-life doctors, the ethics of might-makes-right. (We are bigger than you, more powerful than you and so we will make you agree with us or shut you down.)

How sad! Do they not understand the battle is not ours? And the battle belongs to the LORD?

Following is a piece I wrote hoping to have it published. It doesn’t look like it will be, so I am posting it here. It regards family size. I hope you enjoy the read as much as I enjoyed writing it.

Missing the Joy

Everyone knows we live on an over-populated planet. Too many people (carbon footprints) harm our environment causing global climate change, a threat to us all. In addition, increasing population means more poverty and starvation. Socially responsible adults must respond by limiting their family size.

What I just wrote is nonsense, of course, but is religion to environmentalists and accepted by many if not most Americans. In spite of such bleak pronouncements, abundant space remains in and on this world for more people. The sun controls our weather more than we thought. Carbon dioxide helps plants grow. Denmarkand Japan, two densely populated countries, experience remarkable prosperity in spite of (because of?) their many citizens. Dishonesty, graft, greed and corruption seem to contribute more to poverty and starvation in third world countries than anything else. It’s hard to do business with a dishonest person or run a business in a country with a corrupt government.

But what does a socially responsible young adult do about family? Should a couple have children? If so, how many? Is a large family a curse on the planet or a blessing? As Psalm 127 says,

3 Behold, children are a heritage from the Lord,
the fruit of the womb a reward.4 Like arrows in the hand of a warrior
are the children of one’s youth.5 Blessed is the man
who fills his quiver with them! (ESV)

I deal with this issue everyday in my OB/GYN practice. It’s my job to inquire about childbearing desires, an inquiry which always leads to a discussion of family size. When I ask women if they will have children, or have more children, I usually get a ‘you-just-want-more-OB-business’ comment with a sly smile. But when I press, the comments I hear are almost always the same: We have the perfect family, a boy and a girl; my husband won’t let me; day care is too expensive; we just moved into a new house and can’t afford another child; one child is too much hassle, more would be worse; we want to travel and have fun; we should limit our family to not hurt the planet. Money. Time. Fun. Job. Daycare. Travel. Hassle. Husband. Environmental responsibility. Such are the reasons I hear for limiting family size.

I’ll ask to share my perspective on family size. If permitted, I do my best to counter such arguments and am occasionally persuasive.

For those with money trouble, I counter by saying there has never been a better time to afford children. Discount stores and thrift shops dot the cities and towns. Frugality is not poverty. The most important things a parent can give a child—time, support, love, care, discipline and training—cannot be bought with money. A strong social safety net protects in the event of hard times. No one starves.

To the hard-core environmentalists, if pressed, I mention Denmarkand Japanas examples of countries maintaining a healthy environment with dense populations and present the view that people are the solution, not the problem.

It’s harder to counter the “perfect family” argument and the “we want to have fun” argument. To that I ask if her children bring her joy. And, of course, they do.

Then I ask if I can share my Thanksgiving story. I’ve never been turned down.

Thanksgiving—it’s a busy day at the Andersonhouse. Family and friends arrive from all over. People trickle in, some bringing food, some Thanksgiving cards, some half a gaggle of kids and everyone their appetites. Decorations of turkeys and pilgrims delight the little ones. The smell of food fills the house. In the kitchen, a passel of woman (and men) prepare food in abundance as talking fills the air. Discussions of kids, jobs, cars, church, joys and sorrows go on between where’s-this-bowl and what-shall-I-add-to-this. In the living room, three sit discussing politics. Four play a board game at the kitchen table. Toddlers run, scream, fall, laugh and cry. Babies are admired, diapers are changed, naps go on in the quiet rooms and comments are made about how every child is taller this year. Eventually, everyone gathers at the table where I read a thanksgiving Psalm and pray, thanking God for His providence, praying for those in need, remembering with sorrow the close family and friends who have passed on and blessing those who could not attend for one reason or another. Everyone eats as conversations continue. A few do the dishes, sometimes even joyfully, as most bundle up for the football game outside where someone is always learning the game and someone always gets hurt.

Then I tell them that when they get to my age, material things—cars, houses, bank accounts—dim in importance. But family, this gift of God, provides abundant, often indescribable, joy. Even with the sorrow of loss, family events like that are as close to heaven as I’ll ever get this side of glory. I tell her my desire for her to have children has nothing to do with my OBbusiness, but everything to do with her joy. Don’t give up the joy! Don’t settle for “stuff”—money, cars, homes, travel, big retirement nest eggs—just stuff—when you can have family!

Of course, everyone knows families can be dysfunctional, traumatic, abusive and broken. Just read a newspaper. But the Psalmist had it right. Children are a reward and a joy, not a carbon footprint destroying the planet.

This morning, I read Psalm 61. That God would speak through His word continually amazes me. My meditation on Psalm 61.

Lead Me to the Rock

To the choirmaster: with stringed instruments. Of David.

Lead Me to the Rock

To the choirmaster: with stringed instruments. Of David.

61:1 Hear my cry, O God,
listen to my prayer;2 from the end of the earth I call to you
when my heart is faint.
Lead me to the rock
that is higher than I,3 for you have been my refuge,
a strong tower against the enemy.

4 Let me dwell in your tent forever!
Let me take refuge under the shelter of your wings! Selah5 For you, O God, have heard my vows;
you have given me the heritage of those who fear your name.

6 Prolong the life of the king;
may his years endure to all generations!7 May he be enthroned forever before God;
appoint steadfast love and faithfulness to watch over him!

8 So will I ever sing praises to your name,
as I perform my vows day after day. (ESV)

1) To know you hear me is blessing on blessing!

2) When my heart is faint, it feels like I am at the end of the earth. I know you are there, I know I can trust you, but my feeling is gone. Hold me, Oh God!You are my rock, so above me, so strong, so worthy my devotion and worship. Lead to that place of refuge, higher than I can go myself.

3) You have been my refuge against my enemy, but my enemy is myself, my sin, my rebellion. So you are my refuge against…myself. Thank you, Oh God.

4) To dwell in your tent forever is to forever behold your glory, the glory of the one without beginning and without end, here before the universe and here after the universe has melted away. Beholding the glory of the one who spread the stars across the heavens with His finger! Who has named every star.

It seems Great Britain is determined to catch up in two areas–medical malpractice and the concept of wrongful life.

The US leads the world in medical malpractice lawsuits because of our contingency fee system. The contingency fee system means the lawyer gets a percentage, usually a high percentage, of the winnings. Thus, it pays to sue if you win and especially pays to sue if you win big. I think, don’t know for sure, but think we are the only country which has such a system. In other countries, lawyers are paid for the work they do, not on the outcome of the trial. Thus, lawsuits are much less frequent.

But it seems a woman in Great Britain is bucking the trend and is suing for “wrongful birth” (wrongful life is another term that means the same thing). Her baby was born 5 years ago with a disability. Had she known, she contends, she would have aborted. You can read about it here.

How would you feel to know that your mother wanted you dead? Or, at least wanted you dead as an unborn baby? I think I’d be glad I slipped past the abortionist’s suction curette and made it into the world alive. Then, I’d want to leave home as soon as I was able. How do you live with someone you know would have killed you if they knew you were…just you! Warts and all. Disabilities and all. Would you have to apologize to your own mother for your existence?

I object fundamentally to the whole concept of “wrongful life”. (Lawyers sue all the time for “wrongful death.”) I believe life is a gift from God, a gift to be cherished, loved and nutured. We are made in God’s image! Think of that! No other being carries the image of God. What a privilege it is. The Bible says nothing about the disabled being less of God’s image. So to see your own child, made in God’s image, as a wrongful life just sends chills up my spine.